Hepatocellular Carcinoma in Sub-saharan Africa

The book comprehensively covers all aspects of hepatocellular carcinoma (cancer) as it occurs in sub-Saharan black Africans and how the cancer differs from that in other parts of the world, in most of which it occurs infrequently. The first chapter is introduced with a discussion of the difficulty in recording all cases of this cancer in sub Saharan Africa and then covers its epidemiology, emphasising the very high incidence of liver cancer in sub Saharan black Africans. The relatively young age at which the tumor occurs in comparison with the older age of the patients in resource-rich regions is stressed. The sex distribution of the cancer is also discussed. The second chapter describes the ways in which hepatocellular cancer presents in black Africans, its symptoms and signs, and how its presentation differs from that in other parts of the world. The third chapter summarises the grave outlook for patients with the tumor, the very short survival times of the patients, and the reasons for their deaths. The fourth chapter discusses the diagnosis of the cancer and why this is far more difficult than it is in resource-rich countries. The fifth chapter deals with the pathology of the tumor-its similarities and differences from that in other parts of the world. The sixth chapter is the longest in the book, and it deals comprehensively with the causes of liver cancer in sub-Saharan Africa. The major cause is chronic infection with the hepatitis B virus, an infection acquired in early childhood, and the possible mechanisms by which this may cause the cancer. Other less common but still important causes in the subcontinent-such as exposure to the fungal carcinogen, aflatoxin, chronic hepatitis C virus infection, dietary iron overload among Africans, and membranous obstruction of the inferior vena cava-are also discussed. The seventh chapter discusses the difficulty in treating hepatocellular cancer and the poor results obtained in sub-Saharan Africa in comparison with the results of treatment in industrialized countries. The penultimate chapter presents possible ways to prevent the cancer or, at least, to detect it at a far earlier time than is currently the case and when it may be more amenable to treatment. The current status of vaccination in preventing hepatitis B virus infection, and hence liver cancer, is discussed in detail. The final chapter asks the question, "How can we improve the diagnosis and treatment of this dreadful malignant disease?"